EMBOLISM

J. W. THOMPSON
1886 Journal of the American Medical Association  
Aquae. giy. M. S. io to 20 drops every two hours in wineglass of water. This preparation I have used almost exclusively in the treatment of syphilis in both its acute and chronic stages, and the result has been most satisfactory. The tincture ferri chloridi is much improved in its therapeutic action when given with potassium chloride. It is my desire that those of our profession who have not used the potassium chloride may investigate its therapeutic action, of which I can assure them it will
more » ... sure them it will verify my statement. The dose will range from 20 grains to 2 drachms in the twenty-four hours, well diluted with water. The detachment of fibrinous deposits from the interior of the heart is an occurrence so thoroughly recognized and understood by the profession, that it seems almost superfluous for me to invite your attention to this subject. The cases to which I desire especially to direct your attention, contain nothing that has not been carefully canvassed by more competent observers than myself. Yet aside from the interest they may possess for the ophthalmologist, they are sufficiently rare from a broader standpoint to possess also much interest for the general practitioner. It could scarcely be considered a presumption in me to believe that you will readily pardon me for being found occasionally outside of the strict limits of my specialty, discussing matters that are of vital interest to both you and me. The links that connect diseases of the eye with systemic diseases are numerous. To understand and to treat diseases of the eye intelligently and successfully, require a theoretical and practical knowledge of the treatment of systemic diseases. Embolism is only a symptom and it is not infrequently seen by the ophthalmologist in the early stages, from the very fact that small arteries, such as the retinal, are often obstructed first. The very circumstance of the existence of an embolism, whether it be of the retinal artery or of any other, presupposes at least a disease of the heart or large arteries. One of the cases to which I shall directly invite your attention proved to be only a symptom of an existing endocarditis. In this disease paresis of the heart constitutes the actual danger while valvular lesions form the ultimate danger. In the beginning of endocarditis, before there has been any detachment of vegetations to obstruct even small arteries, the functional disturbances and subjective symptoms have no well marked characteristic features. The most of them appear either isolated or combined in other diseases of the heart and its envelopes, or even in the affections of distant organs. It is then upon the physical signs alone that a diagnosis can be founded, 1 Read before the Minnesota State Medical Society, in Minneapolis, June 17, 1886. since the antecedent symptoms can only furnish presumptive evidence as to the nature and seat of the lesion. The symptoms of endocarditis and pericarditis so closely resemble one another that they may be confounded and can only be accurately distinguished by means of auscultation. The auscultatory signs by which a differential diagnosis can be determined are as follows : " In endocarditis the murmur is synchronous with the first sound of the heart, and does not occur with the diastole unless régurgitation takes place through the aortic or pulmonary semi-lunar valves, and the murmur is heard loudest at the apex of the heart." " In pericarditis the murmur is not exactly synchronous with the valvular sounds, and often occurs during both the systole and diastole of the heart, and the murmur is heard loudest at the border of the sternum near the fifth left costal cartilage." This affection of the heart is frequently caused by rheumatism, chorea, i>y;cmia, or the acute exanthematous fevers (Ingals). In endocarditis numerous vegetations accumulate on the surface of the aortic or mitral valves. These vegetations become detached and float about in the circulation, occasionally plugging up small arteries, and when large enough larger arteries become obstructed by them. The secondary affections that may result from this infarction of different arteries by these detached vegetations are loss of vision from obstruction of retinal artery, gangrene of a leg or an arm by cutting off the circulation, swelling and inflammation of the spleen, acute atrophy of the liver, pncumonitis, cerebral disease, etc. Case /. A man, Mr. L. C, aged about 30, of very stout build, a carriage ironer by occupation, and with an excellent family history on both sides, consulted me on account of a very sudden blindness of his left eye. Up to this time he had enjoyed very good health with the exception of a slight attack of rheumatism which had occurred a few weeks before I saw him. From this, however, he seemed to have fully recovered. On ophthalmoscopic examination I observed the very characteristic appearances of an embolism of the retinal artery. The optic disc was quite pale and transparent, and the arterial vessels thin, and here and there changed into white bands with an occasional red plug of coagulum. The media was quite clear. In the course of a week or ten days there was a well marked improvement, absorption having taken place and the circulation in the retina began to be reestablished with a return of a considerable amount of sharpness of vision. In the course of a week or ten days vision in this eye had so far advanced that he could see to go about very comfortably. The other now became affected in a like manner and pursued a similar course. When this one began to improve, the one first attacked had very nearly recovered full sharpness of vision. Examination by auscultation revealed, but not clearly, what seem to me to be an endocarditis. I consulted a brother practitioner for whose opinion I entertained much respect, and he confirmed my diagnosis. In a few weeks the physical signs of endocarditis became better marked, when he was suddenly seized with a severe pain in his right arm which extended
doi:10.1001/jama.1886.04250070100004 fatcat:eugjgcqtsjecbkhwmpkmvxbogi